Provider Demographics
NPI:1114207081
Name:SCRUGGS, DANA M (MS, RD)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:M
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CADLONI LN
Mailing Address - Street 2:APARTMENT G
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8499
Mailing Address - Country:US
Mailing Address - Phone:901-563-7501
Mailing Address - Fax:
Practice Address - Street 1:203 CADLONI LN
Practice Address - Street 2:APARTMENT G
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8499
Practice Address - Country:US
Practice Address - Phone:901-563-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00720649133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered